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Pharmacology- Exam #4 > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

What is the MC movement disorder?

A

Tremor

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2
Q

What is the MC neurologic cause of postural or action tremor?

A

Essential Tremor

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3
Q

Essential Tremor treatment

A

Long Acting Propanolol

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4
Q

Propanolol SE’s

A
  1. Lightheadedness
  2. Fatigue
  3. Impotence
  4. Bradycardia
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5
Q

Who should you caution with propranolol?

A
  1. Heart block
  2. Asthma
  3. Type 1 diabetes mellitus
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6
Q

List the anticonvulsant used for treatment of essential tremors

A
  1. Primidone
  2. Topiramate
  3. Gabapentin
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7
Q

What is the max dose where there is no benefit beyond that in Primidone

A

750 mg/daily

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8
Q

Main SE’s of Primidone

A

Sedation

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9
Q

Topiramte MOA

A

Enhances GABA activity

Blocks voltage-gated sodium channels

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10
Q

Toprimate ADEs

A

Concentration difficulty

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11
Q

Gabapentin ADEs

A
  1. Gait unsteadiness

2. “Brain fog”-interferes with memory

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12
Q

What does Botulinum toxin type A injection provide MODEST benefit in?

A

Limb tremor

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13
Q

What Botulinum toxin type A injection POSSIBLY reduce?

A
  1. Head tremor
  2. Voice tremor
    * Limited data
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14
Q

ADEs of Botulinum toxin type A in treatment of voice tremor

A
  1. Breathlessness
  2. Hoarseness
  3. Swallowing difficulty
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15
Q

Benzodiazepines MOA

A

Enhances GABA activity

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16
Q

Why are Benzodiazepines second-line choice in treating essential tremors?

A

Dependence issues

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17
Q

What part of the brain does Huntington’s dz affect?

A

Basal Ganglia

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18
Q

How would you treat chorea in huxngtingtons?

A

Central Monoamine Depleting Agents

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19
Q

List the Central Monoamine Depleting Agents

A
  1. Tetrabenazine

2. Deutetrabenazine

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20
Q

SE’s of Tetrabenazineand Deutetrabenazine

A

Depression

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21
Q

Haloperidol MOA

A

Blocks Dopamine

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22
Q

Haloperidol clinical application

A
  1. Tourette’s Syndrome

2. Huntington’s chorea

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23
Q

Haloperidol SE’s

A

Extrapyramidal dysfunction

–>Get Parkinson’s like movements D/T this

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24
Q

What would you use atypical antipsychotics in the treatment of?

A
  1. Tourettes

2. Schizophrenia: Improves both positive and negative sx’s

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25
Q

Tourettes Treatment for severe motor and phonic tics who have failed standard tx?

26
Q

Pimozide MOA

A

dopamine receptor antagonist

27
Q

Pimodize SEs

A
  1. Sedation
  2. Akathisa/Akinesia
  3. Ocular accommodation decreases
28
Q

What is the hallmark finding in Tourettes syndrome?

A

Phonic tics, onset during childhood

29
Q

What associated disorder occurs in 60-70% of youth with chronic tics or Tourettes syndrome

30
Q

When is iron replacement indicated in the treatment of restless leg syndrome?

A

Serum Ferritin <75 mg/L

31
Q

How do we choose therapy in restless leg syndrome?

A

Based on comorbid conditions

32
Q

List the two medication used for INITIAL treatment in restless leg syndrome

A
  1. Pramipexole

2. Ropinirole

33
Q

Treatment for INTERMITTENT RLS associated with triggers from traveling by auto or airplane or specific events with prolonged sitting

A

Carbidopa-Levodopa

34
Q

What is the max daily dose for Levodopa in the treatment of INTERMITTENT RLS?

A

200 mg/day

35
Q

What population can we use benzodiazepines in with the treatment of RLS?

A

Younger patients

36
Q

Benzodiazepines SE’s

A

“Benzo hangover”: Cognitive impairment in the morning

37
Q

List the dopamine agonist used in the treatment of PERSISTENT RLS

A

Pramipexole

38
Q

Pramipexole ADE’s

A
  1. Fatigue
  2. Nasal Stiffness
  3. Risk of impulse control disorder
39
Q

Who should we avoid giving Pramipexole to?

40
Q

List the Alpha-2-Delta Calcium channel ligands used in the treatment of PERSISTENT RLS

A
  1. Gabapentin

2. Pregablin

41
Q

Indication to use Gabapentin or Pregablin?

A

Comorbid insomnia or sleep disturbances that is disproportionate to other RLS sx’s

42
Q

Treatment for REFRACTORY RLS?

43
Q

List the chelating agents used in treatment of Wilson’s Dz

A
  1. D-Penicillamine

2. Trientine

44
Q

D-Penicillamine MOA

A

Free sulfhydryl group that function as a copper chelating moiety

45
Q

What do you want to give to prevent pyridoxal phosphate deficiency seen when using D-Penicillamine

A

Pyrodoxine (B6)

46
Q

What is the major SE we are concerned about with Trientine-Copper chelator? How do we avoid this?

A

Nephortoxicity D/T trientine iron complex

Avoid coadministration of iron with Trientine

47
Q

Oral zinc MOA in treatment of Wilson’s Dz?

A

Interferes with absorption of copper excreted in the stool

48
Q

What does ALS (Lou Gehrig’s Dz) SPARE?

A
  1. Sensory
  2. Autonomic
  3. Oculomotor
  4. Mental function
49
Q

What is the proposed etiology of ALS?

A

Glutamate reuptake abnormality

50
Q

Lis the two main treatments for ALS?

A
  1. Riluzole

2. Edaravone

51
Q

Riluzole MOA

A
  1. Inhibits Glutamate release
  2. Inactivation of Na+ channels
  3. Interferes with transmitter binding @ excitatory receptors
52
Q

Riluzole ADE’s

A
  1. HTN
  2. Abdominal pain
  3. Increase Transminases
  4. Neuromuscular and arthralgia
  5. Tremor
  6. Decreased lung function
53
Q

What is a serious ADE of Edaravone?

A

Asthmatic reaction

54
Q

List the agents used to treat spasticity in ALS

A
  1. Baclofen
  2. Tizanidine
  3. Clonazepam
55
Q

Balcofen MOA

A

GABA B receptor agonist

56
Q

Baclofen SE’s

57
Q

Tizanidine MOA

A

Alpha 2 agonist in CNS

58
Q

Tizanidine ADE’s

A
  1. Drowsiness
  2. Dizziness
  3. Asthenia (lack of energy)
59
Q

Benzodiazepine (effective anti spasticity) ADE’s

A
  1. Amnesia
  2. Confusion
  3. Drowsiness
  4. Slurred speech
60
Q

What other conditions exhibit Benzodiazepine side effects?

A
  1. Alcohol
  2. Stroke
  3. Dementia
  4. Post-concusive
  5. Hypoglycemia
61
Q

Lis the anticholinesterase inhibitors for treatment of Myasthenia Gravis

A
  1. Pyridostigmine

1. Neostigmine

62
Q

anticholinesterase inhibitor ADE’s

A
  1. SLUDE
  2. Decreased HR
  3. Bronchoconstriction
  4. Constricted pupils

Pharmacology- Exam #4 (6 decks)

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